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Narayanasamy S, Dat VQ, Thanh NT, Ly VT, Chan JFW, Yuen KY, Ning C, Liang H, Li L, Chowdhary A, Youngchim S, Supparatpinyo K, Aung NM, Hanson J, Andrianopoulos A, Dougherty J, Govender NP, Denning DW, Chiller T, Thwaites G, van Doorn HR, Perfect J, Le T. A global call for talaromycosis to be recognised as a neglected tropical disease. Lancet Glob Health 2021; 9:e1618-e1622. [PMID: 34678201 PMCID: PMC10014038 DOI: 10.1016/s2214-109x(21)00350-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/13/2021] [Accepted: 07/22/2021] [Indexed: 02/05/2023]
Abstract
Talaromycosis (penicilliosis) is an invasive mycosis that is endemic in tropical and subtropical Asia. Talaromycosis primarily affects individuals with advanced HIV disease and other immunosuppressive conditions, and the disease disproportionally affects people in low-income and middle-income countries, particularly agricultural workers in rural areas during their most economically productive years. Approximately 17 300 talaromycosis cases and 4900 associated deaths occur annually. Talaromycosis is highly associated with the tropical monsoon season, when flooding and cyclones can exacerbate the poverty-inducing potential of the disease. Talaromycosis can present as localised or disseminated disease, the latter causing cutaneous lesions that are disfiguring and stigmatising. Despite up to a third of diagnosed cases resulting in death, talaromycosis has received little attention and investment from regional and global funders, policy makers, researchers, and industry. Diagnostic and treatment modalities remain extremely insufficient, however control of talaromycosis is feasible with known public health strategies. This Viewpoint is a global call for talaromycosis to be recognised as a neglected tropical disease to alleviate its impact on susceptible populations.
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Affiliation(s)
- Shanti Narayanasamy
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Vu Quoc Dat
- Department of Medicine, Hanoi Medical University, Hanoi, Vietnam; Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Nguyen Tat Thanh
- Woolcock Institute of Medical Research, Ho Chi Minh City, Vietnam
| | - Vo Trieu Ly
- Department of Infectious Diseases, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; Ward E, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Jasper Fuk-Woo Chan
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, and Hainan Medical University-The University of Hong Kong Joint Laboratory of Tropical Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Kwok-Yung Yuen
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, and Hainan Medical University-The University of Hong Kong Joint Laboratory of Tropical Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Chuanyi Ning
- BSL-3 Lab Core and Guangxi Key Laboratory of AIDS Prevention and Treatment, Life Sciences Institute, Guangxi Medical University, Guangxi, China
| | - Hao Liang
- BSL-3 Lab Core and Guangxi Key Laboratory of AIDS Prevention and Treatment, Life Sciences Institute, Guangxi Medical University, Guangxi, China
| | - Linghua Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Sirida Youngchim
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Ne Myo Aung
- Department of Medicine, University of Medicine 2, Yangon, Myanmar
| | - Josh Hanson
- Department of Medicine, University of Medicine 2, Yangon, Myanmar; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Alex Andrianopoulos
- Molecular, Cellular, and Developmental Biology, School of Biosciences, University of Melbourne, Melbourne, VIC, Australia
| | - John Dougherty
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Nelesh P Govender
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David W Denning
- Manchester Fungal Infection Group, The University of Manchester, Manchester, UK; Global Action Fund for Fungal Infections, Geneva, Switzerland
| | - Tom Chiller
- Center for Disease Control and Prevention, Atlanta, GA, USA
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Hanoi, Vietnam; Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam; Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - John Perfect
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Thuy Le
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA; Oxford University Clinical Research Unit, Hanoi, Vietnam.
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Narayanasamy S, Dat VQ, Thanh NT, Ly VT, Chan JFW, Yuen KY, Ning C, Liang H, Li L, Chowdhary A, Youngchim S, Supparatpinyo K, Aung NM, Hanson J, Andrianopoulos A, Dougherty J, Govender NP, Denning DW, Chiller T, Thwaites G, van Doorn HR, Perfect J, Le T. A global call for talaromycosis to be recognised as a neglected tropical disease. THE LANCET GLOBAL HEALTH 2021; 9:e1618-e1622. [DOI: https:/doi.org/10.1016/s2214-109x(21)00350-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
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Narayanasamy S, Dougherty J, van Doorn HR, Le T. Pulmonary Talaromycosis: A Window into the Immunopathogenesis of an Endemic Mycosis. Mycopathologia 2021; 186:707-715. [PMID: 34228343 PMCID: PMC8536569 DOI: 10.1007/s11046-021-00570-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/07/2021] [Indexed: 01/18/2023]
Abstract
Talaromycosis is an invasive mycosis caused by the thermally dimorphic saprophytic fungus Talaromyces marneffei (Tm) endemic in Asia. Like other endemic mycoses, talaromycosis occurs predominantly in immunocompromised and, to a lesser extent, immunocompetent hosts. The lungs are the primary portal of entry, and pulmonary manifestations provide a window into the immunopathogenesis of talaromycosis. Failure of alveolar macrophages to destroy Tm results in reticuloendothelial system dissemination and multi-organ disease. Primary or secondary immune defects that reduce CD4+ T cells, INF-γ, IL-12, and IL-17 functions, such as HIV infection, anti-interferon-γ autoantibodies, STAT-1 and STAT-3 mutations, and CD40 ligand deficiency, highlight the central roles of Th1 and Th17 effector cells in the control of Tm infection. Both upper and lower respiratory infections can manifest as localised or disseminated disease. Upper respiratory disease appears unique to talaromycosis, presenting with oropharyngeal lesions and obstructive tracheobronchial masses. Lower respiratory disease is protean, including alveolar consolidation, solitary or multiple nodules, mediastinal lymphadenopathy, cavitary disease, and pleural effusion. Structural lung disease such as chronic obstructive pulmonary disease is an emerging risk factor in immunocompetent hosts. Mortality, up to 55%, is driven by delayed or missed diagnosis. Rapid, non-culture-based diagnostics including antigen and PCR assays are shown to be superior to blood culture for diagnosis, but still require rigorous clinical validation and commercialisation. Our current understanding of acute pulmonary infections is limited by the lack of an antibody test. Such a tool is expected to unveil a larger disease burden and wider clinical spectrum of talaromycosis.
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Affiliation(s)
- Shanti Narayanasamy
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA.
| | - John Dougherty
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thuy Le
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA.
- Oxford University Clinical Research Unit, Hanoi, Vietnam.
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Abstract
To investigate the characteristics of spiral computed tomography (CT), positron emission tomography-computed tomography (PET/CT) and clinical manifestations of talaromycosis to improve the diagnostic level and deepen its recognition in radiology.Radiological, clinical, and pathological manifestations of 15 patients of non-HIV talaromycosis confirmed by bronchofiberscope lung biopsy and/or abscess puncture fluid culture and/or blood culture and/or sputum culture were analyzed retrospectively. All patients underwent chest CT, among them, six had a brain MRI, and six had a PET/CT scan before treatment.On plain CT scan, there were multiple patches and massive consolidation in 6 patients, multiple patchy consolidations and patchy ground-glass opacities in 3 patients, solitary or multiple nodules and masses in 3 patients, multiple cavities and small nodules in 3 patients. Multiple lymphadenectasis appeared in bilateral hila, mediastinum, and neck in 10 patients. In contrast CT scan, the parenchyma of the lesions had a slight enhancement in 10 patients, moderate enhancement in 3 patients, obvious enhancement in 2 patients. Seven cases had bone destruction and hyperplasia, cranial involvement in 1 patient and liver involvement in 3 patients, respectively. On PET/CT, five patients showed elevated standard uptake value (SUV).The radiological manifestations of non-HIV talaromycosis show multiple consolidations, ground-glass opacities, multiple nodules or masses in bilateral lungs, deep-seated enlarged lymph nodes and bone destruction in multiple systems. The final diagnosis should be based on the culture of talaromycosis.
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Affiliation(s)
- Xinchun Li
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University
| | - Wenqing Hu
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University
| | - Qi Wan
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University
| | - Qiang Lei
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University
| | - Chongpeng Sun
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University
| | - Zhongjun Hou
- Department of Radiology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nitesh Shrestha
- Department of Radiology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Sethuraman N, Thirunarayan MA, Gopalakrishnan R, Rudramurthy S, Ramasubramanian V, Parameswaran A. Talaromyces marneffei Outside Endemic Areas in India: an Emerging Infection with Atypical Clinical Presentations and Review of Published Reports from India. Mycopathologia 2020; 185:893-904. [PMID: 31894499 DOI: 10.1007/s11046-019-00420-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/14/2019] [Indexed: 11/26/2022]
Abstract
Talaromycosis is a disseminated disease caused by Talaromyces (Penicillium) marneffei, mainly seen in acquired immunodeficiency syndrome (AIDS) patients. Its distribution is restricted to southeast Asian countries; a small pocket of endemicity exists in the northeast Indian state of Manipur. Here, we present a series of five cases presenting to our tertiary care hospital, originating from non-endemic states neighboring Manipur. In addition to the geographical distinction, a variety of unique features were noted in our cases, including human immunodeficiency virus (HIV)-negative hosts, the absence of typical skin lesions, presentation as pneumonia and generalized lymphadenopathy. Our series highlights the importance of distinguishing this disease from histoplasmosis and tuberculosis, both endemic in India.
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Affiliation(s)
- Nandini Sethuraman
- Department of Microbiology, Apollo Hospitals, No.21, Greams Lane, Off Greams Road, Chennai, 600006, India.
| | - M A Thirunarayan
- Department of Microbiology, Apollo Hospitals, No.21, Greams Lane, Off Greams Road, Chennai, 600006, India
| | - Ram Gopalakrishnan
- Department of Infectious Diseases, Apollo Hospitals, No.21, Greams Lane, Off Greams Road, Chennai, 600006, India
| | - Shivaprakash Rudramurthy
- Mycology Section, Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - V Ramasubramanian
- Department of Infectious Diseases, Apollo Hospitals, No.21, Greams Lane, Off Greams Road, Chennai, 600006, India
| | - Ashok Parameswaran
- Department of Histopathology, Apollo Hospitals, No.21, Greams Lane, Off Greams Road, Chennai, 600006, India
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Lin F, Qiu Y, Zeng W, Liang Y, Zhang J. Talaromyces marneffei infection in a lung cancer patient: a rare case report. BMC Infect Dis 2019; 19:336. [PMID: 31014277 PMCID: PMC6480833 DOI: 10.1186/s12879-019-3968-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Talaromyces marneffei is an invasive, and thermal dimorphic pathogenic fungus, whose infection is life threatening in human. Although immunocompromised patients, such as patients with human immunodeficiency virus infection and recipients of organ transplant, are susceptible hosts, infections have been recently reported in people with normal immune function. Patients with cancer may also be susceptible hosts but no case of T. marneffei infection has been reported in patients with lung cancer. In this case, we describe T. marneffei infection coexisting with primary pulmonary lymphoepithelioma-like carcinoma (LELC) in an HIV-negative patient. CASE PRESENTATION A 50-year-old, previously healthy female presented with a 1-month history of cough and fever. CT scans showed a mass in the left lower lung, left pleural thickening, pleural effusion, and multiple swollen lymph nodes throughout the body. Based on the pathology of the left lung lesion, she was diagnosed with left primary pulmonary LELC complicated with T. marneffei. She received both anti-tumor and anti-fungal treatments. A subsequent CT re-examination demonstrated that the mass was absorbed remarkably after treatment. Follow up showed no tumor progression and no relapse of T. marneffei infection. CONCLUSION This case suggested that clinicians should pay more attention to the potential hosts of T. marneffei infection, especially those with lung cancer. Early diagnosis and treatment can improve the prognosis of T. marneffei infection coexisting with lung cancer.
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Affiliation(s)
- Fanhai Lin
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Ye Qiu
- Department of Comprehensive Internal Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wen Zeng
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Yi Liang
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Jianquan Zhang
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
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Castro-Lainez MT, Sierra-Hoffman M, LLompart-Zeno J, Adams R, Howell A, Hoffman-Roberts H, Fader R, Arroliga AC, Jinadatha C. Talaromyces marneffei infection in a non-HIV non-endemic population. IDCases 2018; 12:21-24. [PMID: 29942740 PMCID: PMC6010951 DOI: 10.1016/j.idcr.2018.02.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 02/28/2018] [Accepted: 02/28/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction Talaromyces marneffei infection is a systemic mycosis, caused by a dimorphic fungus, an opportunistic pathogen formerly known as Penicillium marneffei. This disease is endemic to Southeast Asia and common in human immunodeficiency virus (HIV) infected patients with low CD4 counts. Here we present a very rarely reported case of Talaromyces marneffei infection in an apparent non-immunosuppressed patient presenting decades later in a non-endemic setting (United States). Presentation of case Our patient was a 75-year-old Caucasian Navy veteran, who served in Vietnam as a part of the Swift Boat service in 1966. He presented to his primary care provider with uncontrolled nonproductive cough and abnormal chest computerized tomography. Bronchoscopy specimens showed Talaromyces. He was empirically treated with itraconazole and then switched to voriconazole after confirmation of diagnosis but he later deteriorated was changed to liposomal amphotericin B and isavuconazole. Patient did well for the next 90 days on isavuconazole until the therapy was stopped. Soon after stopping the medication (isavuconazole) his symptoms recurred and ultimately patient expired. Discussion Talaromycosis generally presents as pulmonary infection with manifestations similar with other endemic fungi. It is often seen HIV patients with travel to South east Asia. Very rarely this infection is seen and reported in non-immunosuppressed and in non-endemic areas. To date there are 4 well-documented cases among non-HIV, non-endemic population. Conclusion Talaromyces can cause infection in non-HIV and non-endemic population and could be an underrecognized cause of pulmonary infections among veterans with even a remote history of exposure to the organism during deployment.
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Affiliation(s)
- Miriams Teresita Castro-Lainez
- Universidad Nacional Autonoma de Honduras, Facultad de Ciencias Medicas, Hospital Escuela Universitario, Boulevard Suyapa, Tegucigalpa, Honduras
| | - Miguel Sierra-Hoffman
- Department of Infectious Disease, Citizens Medical Center, 2701 Hospital Dr, Victoria, TX: 77901, United States
| | - Juan LLompart-Zeno
- Department of Medicine, Citizens Medical Center, 2701 Hospital Dr, Victoria, TX: 77901, United States
| | - Robin Adams
- Department of Medicine, Citizens Medical Center, 2701 Hospital Dr, Victoria, TX: 77901, United States
| | - Alan Howell
- Department of Medicine, Scott & White Medical Center, 2401 South 31st Street, Temple, TX: 76508, United States
| | - Holly Hoffman-Roberts
- Nabriva Therapeutics Plc, 1000 Continental Drive, Suite 600, King of Prussia, PA 19406
| | - Robert Fader
- Department of Microbiology, Scott & White Medical Center, 2401 South 31st Street, Temple, TX: 76508, United States
| | - Alejandro C Arroliga
- Department of Medicine, Scott & White Medical Center, 2401 South 31st Street, Temple, TX: 76508, United States
| | - Chetan Jinadatha
- Department of Medicine, Central Texas Veterans Health Care System, 1901 South Veterans Drive, Temple, TX: 76504, United States.,Department of Medicine, College of Medicine, Texas A&M University, 8447 Bryan Rd, Bryan, TX: 77807, United States
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Dai X, Mao C, Lan X, Chen H, Li M, Bai J, Deng J, Liang Q, Zhang J, Zhong X, Liang Y, Fan J, Luo H, He Z. Acute Penicillium marneffei infection stimulates host M1/M2a macrophages polarization in BALB/C mice. BMC Microbiol 2017; 17:177. [PMID: 28821221 PMCID: PMC5563047 DOI: 10.1186/s12866-017-1086-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/09/2017] [Indexed: 12/27/2022] Open
Abstract
Background Penicillium marneffei (P. marneffei) is a thermally dimorphic fungus pathogen that causes fatal infection. Alveolar macrophages are innate immune cells that have critical roles in protection against pulmonary fungal pathogens and the macrophage polarization state has the potential to be a deciding factor in disease progression or resolution. The aim of this study was to investigate mouse alveolar macrophage polarization states during P. marneffei infection. Results We used enzyme-linked immunosorbent (ELISA) assays, quantitative real-time PCR (qRT-PCR), and Griess, arginase activity to evaluate the phenotypic markers of alveolar macrophages from BALB/C mice infected with P. marneffei. We then treated alveolar macrophages from infected mice with P. marneffei cytoplasmic yeast antigen (CYA) and investigated alveolar macrophage phenotypic markers in order to identify macrophage polarization in response to P. marneffei antigens. Our results showed: i) P. marneffei infection significantly enhanced the expression of classically activated macrophage (M1)-phenotypic markers (inducible nitric oxide synthase [iNOS] mRNA, nitric oxide [NO], interleukin-12 [IL-12], tumor necrosis factor-alpha [TNF-α]) and alternatively activated macrophage (M2a)-phenotypic markers (arginase1 [Arg1] mRNA, urea) during the second week post-infection. This significantly decreased during the fourth week post-infection. ii) During P. marneffei infection, CYA stimulation also significantly enhanced the expression of M1 and M2a-phenotypic markers, consistent with the results for P. marneffei infection and CYA stimulation preferentially induced M1 subtype. Conclusions The data from the current study demonstrated that alveolar macrophage M1/M2a subtypes were present in host defense against acute P. marneffei infection and that CYA could mimic P. marneffei to induce a host immune response with enhanced M1 subtype. This could be useful for investigating the enhancement of host anti-P. marneffei immune responses and to provide novel ideas for prevention of P. marneffei-infection. Electronic supplementary material The online version of this article (doi:10.1186/s12866-017-1086-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiaoying Dai
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Congzheng Mao
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Xiuwan Lan
- Guangxi Colleges and Universities Key Laboratory of Preclinical Medicine Research, Nanning, Guangxi, 530021, China
| | - Huan Chen
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Meihua Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jing Bai
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jingmin Deng
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Qiuli Liang
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jianquan Zhang
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Xiaoning Zhong
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Yi Liang
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jiangtao Fan
- Department of Gynecology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Honglin Luo
- Guangxi Medical University, Nanning, Guangxi, 530021, China.
| | - Zhiyi He
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China.
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Keshishyan S, DeLorenzo L, Hammoud K, Avagyan A, Assallum H, Harris K. Infections causing central airway obstruction: role of bronchoscopy in diagnosis and management. J Thorac Dis 2017; 9:1707-1724. [PMID: 28740687 DOI: 10.21037/jtd.2017.06.31] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Central airway obstructive infections (CAOI) are challenging medical conditions that may represent an advanced and complicated process of ongoing infections. The epidemiology of CAOI is unknown as well as the pathophysiology and the mechanism of development. This is due to sparse data in the literature that consists mainly of case reports and retrospective case series. CAOI can be caused by fungal, bacterial, parasitic and viral infections. Most patients with CAOI can be diagnosed clinically and with chest imaging, which demonstrate obstruction of the central airways. However, bronchoscopy is commonly used to confirm and obtain a specific diagnosis to guide specific therapy. In recent years, interventional pulmonology (IP) is becoming widely available and offer a minimally invasive approach for the management of central airway diseases such as cancers, benign strictures, and other conditions. Various bronchoscopic modalities are used to treat central airway obstruction (CAO), such as mechanical debulking, endobronchial laser therapy, electrocautery, argon plasma coagulation, cryotherapy, and airway stenting. In patients with CAOI, the role of therapeutic bronchoscopy is not clearly defined, but many isolated reports in the literature described bronchoscopic intervention in combination with medical therapy as the initial management approach. In this paper, we present cases of CAOI that underwent bronchoscopic intervention as part of their management. We described the infectious etiology, locations, bronchoscopic findings and bronchoscopic modalities for airway management.
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Affiliation(s)
- Sevak Keshishyan
- Division of Pulmonary and Critical Care, Department of Medicine, Westchester Medical Center, Valhalla, New York, USA
| | - Lawrence DeLorenzo
- Division of Pulmonary and Critical Care, Department of Medicine, Westchester Medical Center, Valhalla, New York, USA
| | - Kassem Hammoud
- Department of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Arpine Avagyan
- Division of Internal Medicine, Department of Medicine, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Hussein Assallum
- Division of Pulmonary and Critical Care, Department of Medicine, Westchester Medical Center, Valhalla, New York, USA
| | - Kassem Harris
- Section of Interventional Pulmonology, Division of Pulmonary Critical Care and Sleep, Department of Medicine, Westchester Medical Center, Valhalla, New York, USA
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Chan JFW, Lau SKP, Yuen KY, Woo PCY. Talaromyces (Penicillium) marneffei infection in non-HIV-infected patients. Emerg Microbes Infect 2016; 5:e19. [PMID: 26956447 PMCID: PMC4820671 DOI: 10.1038/emi.2016.18] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/04/2015] [Accepted: 12/08/2015] [Indexed: 12/18/2022]
Abstract
Talaromyces (Penicillium) marneffei is an important pathogenic thermally dimorphic fungus causing systemic mycosis in Southeast Asia. The clinical significance of T. marneffei became evident when the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome epidemic arrived in Southeast Asia in 1988. Subsequently, a decline in the incidence of T. marneffei infection among HIV-infected patients was seen in regions with access to highly active antiretroviral therapy and other control measures for HIV. Since the 1990s, an increasing number of T. marneffei infections have been reported among non-HIV-infected patients with impaired cell-mediated immunity. Their comorbidities included primary adult-onset immunodeficiency due to anti-interferon-gamma autoantibodies and secondary immunosuppressive conditions including other autoimmune diseases, solid organ and hematopoietic stem cell transplantations, T-lymphocyte-depleting immunsuppressive drugs and novel anti-cancer targeted therapies such as anti-CD20 monoclonal antibodies and kinase inhibitors. Moreover, improved immunological diagnostics identified more primary immunodeficiency syndromes associated with T. marneffei infection in children. The higher case-fatality rate of T. marneffei infection in non-HIV-infected than HIV-infected patients might be related to delayed diagnosis due to the lack of clinical suspicion. Correction of the underlying immune defects and early use of antifungals are important treatment strategies. Clinicians should be familiar with the changing epidemiology and clinical management of T. marneffei infection among non-HIV-infected patients.
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Affiliation(s)
- Jasper FW Chan
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China
- Department of Microbiology, The University of Hong Kong, Hong Kong, China
- Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Susanna KP Lau
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China
- Department of Microbiology, The University of Hong Kong, Hong Kong, China
- Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Kwok-Yung Yuen
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China
- Department of Microbiology, The University of Hong Kong, Hong Kong, China
- Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Patrick CY Woo
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China
- Department of Microbiology, The University of Hong Kong, Hong Kong, China
- Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
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De Monte A, Risso K, Normand AC, Boyer G, L'Ollivier C, Marty P, Gari-Toussaint M. Chronic pulmonary penicilliosis due to Penicillium marneffei: late presentation in a french traveler. J Travel Med 2014; 21:292-4. [PMID: 24816045 DOI: 10.1111/jtm.12125] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 02/05/2014] [Accepted: 02/10/2014] [Indexed: 11/28/2022]
Abstract
We report a case of pulmonary penicilliosis due to Penicillium marneffei in an immunocompetent French patient with chronic obstructive pulmonary disease, who had traveled in endemic countries several years before. The long interval between exposure and initial symptoms of infection, and relapse despite prolonged voriconazole treatment are unusual features.
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12
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Boonsarngsuk V, Eksombatchai D, Kanoksil W, Tantrakul V. Airway obstruction caused by penicilliosis: a case report and review of the literature. Arch Bronconeumol 2014; 51:e25-8. [PMID: 24973303 DOI: 10.1016/j.arbres.2014.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/18/2014] [Accepted: 04/25/2014] [Indexed: 10/25/2022]
Abstract
Penicilliosis is an opportunistic infection in HIV-infected and other immunocompromised patients mostly in Southeast Asia, Southern China, Hong Kong, and Taiwan, with respiratory manifestations in about one-third of patients. We report the case of a 26-year-old non-HIV immunocompromised patient presenting with an airway obstruction caused by penicilliosis, together with a review of the literature of this rare condition.
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Affiliation(s)
- Viboon Boonsarngsuk
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Tailandia.
| | - Dararat Eksombatchai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Tailandia
| | - Wasana Kanoksil
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Tailandia
| | - Visasiri Tantrakul
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Tailandia
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13
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Furusawa H, Miyazaki Y, Sonoda S, Tsuchiya K, Yaguchi T, Kamei K, Inase N. Penicilliosis marneffei complicated with interstitial pneumonia. Intern Med 2014; 53:321-3. [PMID: 24531088 DOI: 10.2169/internalmedicine.53.1465] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 71-year-old man with interstitial pneumonia was hospitalized due to a pulmonary infection. He had been living in Thailand and had returned to Japan three months earlier. Antibiotic therapy initially cleared the infection; however, the patient's condition relapsed. Pseudomonas aeruginosa and Penicillium sp. were both detected in sputum and bronchial lavage fluid cultures and Penicillium sp. was identified to be P. marneffei. The infiltration observed on chest radiographs improved following treatment with itraconazole and tazobactam/piperacillin, and no relapse occurred. We herein report the first case of a non-HIV patient with P. marneffei infection in Japan.
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Affiliation(s)
- Haruhiko Furusawa
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
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